NEWSLETTER - FALL 2001
| Dr. I. Howard Fine shaking
hands with President George W. Bush
The Coalition of Medical Specialty Societies is an organization representing
over 450,000 physicians. On July 11, 2001, some of the constituent
societys leaders were invited to meet with President George
Bush regarding the Patients Bill of Rights. As the current president
of the American Society of Cataract and Refractive Surgery, I was
there and had the delightful experience of meeting with the sitting
president and observing first-hand some of the protocol associated
with such a meeting and some of the workings of policy and public
relations surrounding legislation. Approximately 20 representatives
of component societies and some of their staff members were present
at the conference table along with President Bush, Tommy Thompson
(Secretary of Health, Education and Welfare), and Elaine Chao (Secretary
I was immensely impressed with how personable the President is. He
was gracious in his dealings with all of the people present, as well
as his staff, elevator operators, clerks, and everyone with whom he
came into contact. I was also tremendously impressed with how knowledgeable
he is with respect to health care issues and health care policy. He
was looking for feedback from those present regarding the failures
of HMOs to provide needed care. His concerns with respect to Patients
Bill of Rights legislation are that there should be timely access
to specialty care and accountability on the part of HMOs (which he
feels would be best achieved through internal and external appeals
processes rather than legal remedies). At the time of our meeting,
the different versions of this legislation were similar with respect
to access to specialty care but differed with respect to accountability.
The Democrats were largely in favor of early litigation to address
disputes whereas President Bush was adamantly opposed to legal remedies.
He indicated that he would veto such a bill, feeling that it would
result in some employers withdrawing normally provided health care
benefits due to increased exposure to litigation, thereby increasing
the rolls of the uninsured. In his own words, Mr. Bush is adamantly
opposed to practicing medicine in the courtroom.
As you would expect, he had the backing of every physician in the
room. He then went on to discuss other issues and, to our delight,
condemned intrusion into health care by the legal profession along
with government medicine in all its forms. A single-payer system has
been, in his words, demonstrated to be a bad system by
our neighbor to the north. [ top ]
Most of us are familiar with the idea of visual
contrast from the little knob on the television or computer screen
that makes dark things darker and light things lighter. If you turn
it all the way up the image becomes severe; all the way down the image
becomes vague. Adjusting the contrast to the right level enhances
our appreciation of the image before us.
|Mark Packer, M.D
Perception of contrast is critical to good visual function. The
ability to discern an oncoming car in the fog, to read a menu in
dim light and to see the edge of a curb on a bright, sunny day depends
upon good contrast sensitivity.
When we test your visual acuity in the examination room we use
black letters against a bright, white background. This test determines
how sharp your vision is, but it does not test your contrast sensitivity.
Patients experiencing the onset of cataracts may retain good visual
acuity, and be able to read all the way to the bottom of the eye
chart. Nevertheless, they may have lost contrast sensitivity and
have real difficulty driving at night, reading stock prices in the
newspaper or following a golf ball. In addition, contrast sensitivity
declines with age even in people without cataracts!
Ophthalmologists have recognized that visual acuity alone does
not tell the whole story of visual function. One method of measuring
the function of the eye, called wavefront analysis, is helping us
to improve our methods for both cataract and refractive surgery.
Wavefront employs a computer to analyze laser light reflected from
the eye. It paints a picture of the entire optical system of the
eye and enables us to determine the best approaches for improving
I am the Principal Investigator for an exciting new FDA study sponsored
by Pharmacia & Upjohn. Our practice will be one of six sites
in the U. S. allowed to provide a new intraocular lens (IOL) following
cataract extraction. This new IOL was designed with wavefront technology
to restore and enhance contrast sensitivity after cataract surgery.
All three doctors in our practice are enrolling patients in the
As we investigate new technology we will likely find beneficial
ways to improve contrast sensitivity and visual function. For our
patients these advances will mean increased enjoyment of recreational
activities, enhanced safety on the road and a better quality of
life. As one patient recently told me after experiencing the improvement
in her vision after cataract surgery, Its like night
and day. [ top ]
Although excellent results are achieved with
LASIK surgery, individuals with extremely large degrees of nearsightedness
may not have enough thickness to their corneas to safely undergo corneal
refractive surgery. There are limitations in how much nearsightedness
can be treated with the excimer laser and some patients may not be
appropriate candidates for LASIK. These patients, however, might be
candidates for future intraocular lens technologies to treat their
severe nearsightedness. Fortunately, our practice is participating
in the U.S. Phase III Clinical Trials of the Medennium Phakic Refractive
Lens (PRL) and we can offer this exciting new technology to our patients.
| Richard S. Hoffman,
So what is a PRL? The PRL is a flexible lens that is inserted into
the eye and positioned behind the iris (colored part of the eye)
and in front of the natural crystalline lens. It can be thought
of as an implantable contact lens in that it actually floats in
front of the crystalline lens without touching it like a contact
lens floats on the cornea. The PRL is inserted through a small corneal
incision and then gently placed behind the iris. The power of the
PRL is calculated before surgery using the curvature of the cornea,
the length of the eye, and the depth of the front chamber of the
eye as variables in a formula. The power of the PRL is customized
for each individual patient to reduce or eliminate their nearsightedness.
The wonderful aspect of this technology is that the PRL can be removed
if a patient is unhappy with the results or removed and replaced
with a different powered lens anytime in the future if the patients
The clinical trial in our practice has begun. Please contact our
Coordinator, Tony Reynolds, at 687-2110 or firstname.lastname@example.org for more information. [ top ]
| Dr. Fine and Vicky
in front of public building with likeness of Ché Guevera
Aa contingent of the executive committee of the American Society
of Cataract and Refractive Surgery attending a meeting jointly sponsored
by ASCRS and the Cuban Ophthalmological Society. The meeting was
well attended by ophthalmologists from Cuba, other Latin American
countries, and Europe.
Cuba is a fascinating place; a country and society that has seemingly
been frozen in time. Since Castros takeover in 1958, there
has been very little new building; almost all existing buildings
are in a state of very bad repair but still show the beauty of the
Colonial architecture that pre-existed the Castro regime. Automobiles
are all from the 50s and are in a state of patched-up repair,
but most are completely functional. A Cuban cannot have a driving
license unless he or she has a car, and therefore every possible
measure is taken to keep cars operational.
We were impressed with the omnipresence of Latin rhythms and music.
It seemed as if there were a salsa band on every corner in Old Havana.
Cuba is responsible for the majority of Latin American rhythms with
which North Americans are familiar, including rumba, cha-cha-cha,
mambo, and salsa. We had an opportunity to visit a music hall and
had a thrilling night of spectacular music, accompanied by our enjoyment
of wonderful Cuban cigars.
| Dr. Hernandez and Dr.
Cuban ophthalmologists are extremely limited in terms of equipment
and facilities for providing patient care and are very poorly paid
(as is nearly everybody within this society). The government essentially
takes all of the productivity of the people. The average Cuban ophthalmologists
salary is $25 per month, which is striking when you consider that
we thought nothing of tipping our bellhop $ 5.00. In spite of how
poorly they are paid and how limited they are, Cuban ophthalmologists
are enormously motivated to learn as much as they can in order to
improve their skills and provide better care for their patients.
While in Cuba, we met and befriended a young leader of Cuban ophthalmology,
Dr. Raul Hernandez. We sponsored his recent trip to Eugene to spend
a week in our clinic, studying our methods and techniques which
he will now take back to Cuba and teach to others. We thoroughly
enjoyed Rauls presence here. He used his time well and exhibited
an insatiable appetite for learning and observing new techniques
and modalities of therapy for cataract and refractive surgery patients.
He also enjoyed our city and was able to spend one afternoon attending
the Eugene Celebration; a unique experience for him.
Hopefully, the United States will be able to strengthen its ties
with Cuba and we will be able to return there for more educational
and humanitarian endeavors. [ top ]
while looking for a LASIK clinic, several people who have had the procedure
recommended Dr. Fine and his staff. They raved about the staffs
courtesy and professionalism and the special calming effect upon their
arrival on their big day. I am the skeptic and like to see for myself.
I honestly thought there wasnt any way that these people could
meet my standards. I was very wrong.
From my first time in the office, I felt comfortable and pleased with
Dr. Fine and his staff. They worked around my difficult schedule and
were able to answer all my questions with a genuine smile. They love
what they are doing.
Now to the surgery
What can I say? Ive worn glasses for
twenty years. Without them I couldnt see more than five inches
in front of me. Now, I amazingly see without glasses or contact lenses,
there is no glare from lenses and colors seem brighter. Being an active
swimmer, the biggest thing for me is to be able to open my eyes under
water, free of goggles.
The surgery itself was a piece of cake, too. I literally walked in
and in about ten minutes I went from being blind to seeing. How can
anything like that be put into words?
I just wanted to write a letter to say thank you. It is the best choice
I ever made and I wish the wonderful staff and Dr. Fine well. Thank
even though I feel that is small in comparison to what you
have given to me. [ top ]